Managerial functioning and preventative care in Kuwait's health system

Health System of Kuwait

The Managerial Functioning of Kuwait's Health Care System

General Description of the Kuwait Health System

Kuwait claims to have one of "the most comprehensive health care systems, and one of the most all-encompassing social service systems in the world" (KIO, 2003). This health care system has offered free - or nearly free - services to the entire population of Kuwait for about fifty years.

If a Kuwaiti citizen is sick, that person is cared for at no charge; if a person is in an auto accident, or needs an examination for an emerging skin irritation, health service is provided. Free health service is also extended to veterinary medical care for livestock and animals. If a sheep herder finds one of more of his animals is diseased, veterinarians will provide care for that disease. If a family dog is hit in the road and suffers broken legs, a Kuwaiti government veterinarian will provide medical service for that family's dog.

A brief history of the origins of the Kuwait health care system is germane to a thorough understanding of the issues. The very first medical clinic for men in Kuwait was built in 1911, and the first hospital for women was established in 1919. These facilities were developed by the Arabian Mission of the Dutch Reform Church (from the United States), and their development was at the request of Amir Sheik Mubarak Al-Sabah. And in 1934, the Olcott Memorial Hospital opened, followed by the Amiri Hospital in 1949. All medical services were "socialized" by the 1950s, as massive oil revenues began to pour into the government's coffers from the rich oilfields being developed in Kuwait.

As an empirical indication of the progress in preventative health care in Kuwait, the incidence of rheumatic fever - in children from 5 to 14 years of age - declined from 3.7 cases per 100,000 people in 1984, to 2.5 cases per 100,000 in 1988 (Majeed, 1993). Further, the nutritional status of Kuwaiti elementary school children ages 6 through 10 was studied in 1985, and then again in 1995, by researchers from the International Journal of Food Sciences and Nutrition (al-Isa, 200). The results of the study - which surveyed 8,957 children - showed that the children "...to be fatter and slightly taller, but nonetheless more nutritionally sound than a decade earlier." Thus, the health system in Kuwait is clearly providing more than just care for the ailing; they are also addressing nutrition, which of course is one aspect of preventative medicine.

How does Kuwait Finance their Health Service System?

Kuwait has the good fortune of being one of the leading oil producing states in the world. Being a giant oil-producing nation means having enormous amounts of financial resources in hand. Those resources allow Kuwait to provide its citizens - and foreigners living in Kuwait - with nearly 100% free medical care and services. As to the amount of oil in Kuwait, according to the U.S. Dept. Of Energy (EIA, 2003), Kuwait is blessed with ownership of about 9% of the world's known oil resources, some 96.5 billion barrels. In addition, Kuwait claims ownership of about half of the "Neutral Zone" area oil - which it shares with Saudi Arabia - totaling some 2.5 billion barrels of oil. All that oil translates into an impressive 40% of Kuwait's Gross Domestic Product (KIO, 2003). At the present time, Kuwait's production capacity is approximately 2.5 million barrels per day - and with the price of crude presently about $30 per barrel on the international market, and Kuwait exporting 60% of its crude that translates to a substantial profit. This year, Kuwait's real GDP is expected to grow by 3.3% (EIA, 2003), and of course oil is what drives those GDP figures upward. Kuwaiti net oil export revenues in 2003 are projected at $15.4 billion, up 32% over 2002 revenues, and significantly higher than the $9.7 billion in revenues assumed by Kuwait for its 2003/2004 budget. Moreover, Kuwait is forward-thinking as to its rich reserves of oil. Kuwait knows oil will not be in the ground forever, so it has a program called "Future Generations Fund," which channels about 10% of its oil revenues each year into a special untouchable account. As of the year 2,000, Kuwait had amassed about $50 billion in that account.

When did oil production begin in Kuwait? It's important to understand that for hundreds of years, oil seepages in the Kuwaiti desert had indicated that there was oil below the surface. This bounty of oil came to the attention of European and U.S. companies.

In 1911 the Anglo-Persian Oil Company (APOC), which was building oil fields in Iran, asked permission to negotiate a concession from Kuwait. The British government refused the request (as it was entitled to do so under an 1899 treaty, when Britain was authorized to take substantial control of Kuwait's foreign policy); but two years later the British government conducted a survey of the geology of the area, and in 1913 the British reached an agreement with Kuwait's Shaykh Mubarak the Great. Mubarak promised to grant concessions only to those oil firms approved by the British government. World War I interrupted another effort to negotiate a concession. By this time, the British government had purchased 51% ownership in APOC as part of an effort to ensure oil supplies for the Royal Navy. In the 1930s, the U.S. pressured Britain to share some of the oil rights, and Gulf Oil developed some wells in a joint agreement with the British. Still, though, not much oil exploration was being done by the Kuwait government.

After WWII, however, on June 30, 1946, Kuwait began its own commercial export of crude oil, as Sheikh Ahmad Al-Jaber Al-Sabah, the Amir of Kuwait, opened the valve to load Kuwait's first shipment of crude. The oil went into a 12,000 metric ton British Petroleum Company tanker, called the "British Fusillier."

Implementation of Kuwait Health System

How is health care implemented for Kuwaiti citizens in 2003? There is a system of local clinics, which are available near community centers and neighborhood co-op supermarkets. According to International Science Review, there are 70 general area-specific clinics (or "centers"), and 141 specialized area-specific health clinics. The clinics do not provide surgeries and other more complicated services, however - they are primarily for "routine check-ups and preliminary examinations." There are five health-care regions in Kuwait, and in each region, there is one main federally-operated hospital (plus there is one additional hospital that has been built since these data were offered by the Kuwait government. The five hospitals are: Amiri Hospital in Kuwait City; Jahra Hospital in Jahra; Farwaniyah Hospital in Farwanijah; Mubarak Al-Kibir Hospital in Jabriya; and Adan Hospital in Fahaheel. The growth of the availability of doctors in Kuwait is quite dramatic. For example, there were only 362 doctors in Kuwait in 1962, but by 1997, thirty-five years later, physicians in Kuwait numbered 3,421 in government service and 324 doctors in the private sector.

As of three years ago, there were a total of 4425 hospital beds, 3,375 doctors, 7,757 nurses, and 3,396 other medical staff on board the government-run facilities. In the private sector, there are 8 hospitals (with 550 beds), 143 generalized / dental clinics. All told, 466 doctors and 960 nurses work in the private health care sector.

The doctors and nurses and medical technicians that implement hands-on health care in the clinics and hospitals are trained in the following facilities: the Faculty of Medicine University (established in 1973); the College of Medical Science and Allied Health (built in 1982); and the College of Pharmacy and College of Dentistry (established in February, 1996). These facilities are the result of an ordinance issued by the Amir in July, 1973; or, in other words, a decree.

Foreign expatriates who live in Kuwait are eligible for some of the medical services available to residents. The clinics spread throughout the country will serve foreigners, either at a nominal fee or free. At hospitals, foreigners may receive free outpatient and emergency services, but they are charged a fee that amounts to $3.34 in U.S. currency. Should a foreign patient need to be served by a medical specialist in a Kuwait hospital, the fee is about double, or around $6.70 U.S. currency.

There is a caveat to the fee structure for foreigners - and that is, all specialist doctors and hospitals have the right, if they wish, to "exempt their patients of all charges."

This is a key fact, because Public Authority of Civil Information reported (in 1999) that the population of Kuwait was approximately 2,274,000; and of those, only 798,200 were actually Kuwaiti citizens. Therefore, free, or nearly free, medical services, to about 1,475,800 foreigners, represent a substantial commitment to good and readily available health care by the government of Kuwait.

An Evaluation of the Health Care System in Kuwait

First of all, when presenting a case for evaluation, one looks at the commitment of the government. In the case of Kuwait, in 1986, the government was spending 5.2% of its GNP on health care, and ten years later, in 1996, with more than double the national budget, the government was allocating 2.7% of its GNP on health care (Burney, 1999). Today, according to the World Health Organization, 3% of GNP goes to health-related services. That is outstanding for any nation. The commitment of the Kuwaiti government is also shown in the growth of expenditures: for example, since 1970, the public expenditure on health care has increased nearly 18-fold. Between the years 1970 and 1996, the ratio of population to doctors declined from 958 to 597; in those same years, the ratio of population to nurses shrunk from 262 to 226. Other positives for Kuwait in the health delivery field? 1) The average life expectancy at birth (LEAB): in the aforementioned years, life expectancy increased from 69 years to 74.8 years. 2) The crude death rate (CDR): it declined from 5 per 1,000 population to 2.9 per 1,000 population in the 26 years between 1970 and 1996. 3) The infant mortality rate (IMEL): it declined from 51.7 per 1,000 live births, to 11.4 per 1,000. And the share of communicable diseases resulting in deaths dropped from 33% to 8% in those same years. All those data are courtesy Nadeem A. Burney, et al., in the International social Science Review.

Data supplied by the World Health Organization (WHO) provides dramatic evidence that there are many more "strong points" than "weak points" in Kuwait's health care system. For example, comparing Kuwait to nearby nations in terms of "government expenditures on health, as a percentage of all money spent on health" - Kuwait's government spends 87.2% of all health-related spending in the country. Oman is next, with 82.9%; Saudi Arabia is 79.1; Tunisia is 78.2; United Arab Emirates is 72.7; and way down at the bottom of the scale in neighboring nations to Kuwait is Sudan, at 21.2%.

Total government spending on health care, as a percentage of GNP, shows Kuwait at 3%, far below Lebanon's 11.8%, but one has to factor in the huge amount of money Kuwait has to spend, versus the relatively small GNP in Lebanon. As to immunization of children against diseases, Kuwait would appear to be doing everything correctly. For instance, there were zero reported cases of Diphtheria from 1990 to 2001, according to World Health Organization data, and only 206 cases of measles in that same time period.

Kuwait certainly faced a health care crises when Iraqi forces invaded Kuwait on August 2, 1990. According to a report by the Physicians for Human Rights (PHR) (Brennan, 1992), there were "mass arrests, torture during interrogation, summary executions...and the plundering of Kuwaiti institutions...[and] claims were made that medical care institutions had been abused, specifically that there had been stationing of military personnel [from Iraq] in and around hospitals." These invading forces, according to PHR, "interfered with the delivery of health care services, assaulted health professions, removed medicines, equipment and supplies from hospitals." Several doctors told PHR researchers they were prohibited from entering their hospitals by the soldiers. Some health care workers were reported killed for providing emergency medical care to Kuwaitis injured by bombs and gunfire. And many other health care personnel fled the country.

Despite these challenges, once the allied forces had driven Iraq out of Kuwait, the health care services in Kuwait returned to normal in remarkable fashion, according to the report. This fact alone sheds light on the quality of the managers and directors who oversee health care in Kuwait. And it would see, as long as the oil continues to flow, Kuwaitis will receive nearly all health care services at no charge - and that, too, says a lot about how effective management is supposed to function in the delivery of key human services to its citizens.